目的 探讨儿童蒽环类药物致心肌病的临床特征、高危因素、检测手段、预防和治疗手段.方法 总结4例蒽环类药物致心肌病患儿的临床资料,并回顾分析相关文献.结果 4例患儿在2.5 ～6.5岁时因急性淋巴细胞性白血病开始化疗,1例化疗8个月时出现心慌,未重视.4例均在化疗结束后逐渐出现水肿、胸闷、活动后气促、肝脏肿大等心力衰竭的表现.柔红霉素总剂量达525 ～1038mg/m2.超声心动图类似扩张型心肌病表现,以左心扩大为主的全心扩大,心脏收缩功能障碍.经抗心衰治疗,1例患儿在1年后死亡.另3例存活4～6年以上,曾有过一段时间的临床症状相对稳定期,但是疾病仍然会缓慢进展.结论 蒽环类药物致心肌病一旦发生将是不可逆性的改变,虽然合理的抗心衰治疗能使病情暂时稳定.药物累积剂量是其主要危险因素.化疗前中后可选择心电图、超声心动图以及血清学指标等监测药物毒性反应.%Objective To explore the clinical characteristics, risk factors, test facility, prevention and therapeutic regimen of anthracycline-induced cardiomyopathy in children. Methods Clinical data of four children with anthracy-cline-induced cardiomyopathy was retrospectively analyzed, and relevant literatures were reviewed. Results Four cases aged from 2. 5 to 6. 5 years, were diagnosed as acute lymphocytic leukemia and undertaked chemotherapy. One case felt flustered after 8-months chemotherapy, but this was not taken attention. Four cases all gradually showed the manifestation of heart failure, like edema, chest distress, exertion breathlessness, hepatic enlargement and so on, after the termination of chemotherapy. The cumulated doses of daunorubicin reached 525 ~ 1038mg/m . Findings of dilated cardiomyopathy were demonstrated by echocardiography. The therapy was aimed mainly to heart failure. One case died 1 year later, and the life spans of the other three cases were over 4 ~ 6 years. Conclusions Anthracycline-induced cardiomyopathy is irreversible, although reasonable treatment aimed directly to heart failure can stabilize temporally the patients' condition. The cumulated anthracycline doses are the most important risk factors. Eletrocardiogram, echocardiogram and serum markers should be tested to monitor the drug side effects.
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